Antonio Giulio de Belvis1,2, Franziska Michaela Lohmeyer3, Andrea Barbara3, Gabriele Giubbini3, Carmen Angioletti1, Giovanni Frisullo2,4, Walter Ricciardi3,5,6, Maria Lucia Specchia3. 1. Department for Evaluation of Clinical Pathways and Outcomes, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy. 2. Università Cattolica del Sacro Cuore , Rome, Italy. 3. Institute of Public Health/Hygiene Section, Università Cattolica del Sacro Cuore , Rome, Italy. 4. Department of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy. 5. Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy. 6. Italian National Health Institute , Rome, Italy.
Abstract
PURPOSE: A clinical pathway for patients with acute ischemic stroke was implemented in 2014 by one Italian teaching hospital multidisciplinary team. The purpose of this paper is to determine whether this clinical pathway had a positive effect on patient management by comparing performance data. DESIGN/METHODOLOGY/APPROACH: Volume, process and outcome indicators were analyzed in a pre-post retrospective observational study. Patients' (admitted in 2013 and 2015) medical records with International Classification of Diseases, ICD-9 code 433.x (precerebral artery occlusion and stenosis), 434.x (cerebral artery occlusion) and 435.x (transient cerebral ischemia) and registered correctly according to hospital guidelines were included. FINDINGS: An increase context-sensitive in-patient numbers with more severe cerebrovascular events and an increase in patient transfers from the Stroke to Neurology Unit within three days (70 percent, p=0.25) were noted. Clinical pathway implementation led to an increase in patient flow from the Emergency Department to dedicated specialized wards such as the Stroke and Neurology Unit (23.7 percent, p<0.001). Results revealed no statistically significant decrease in readmission rates within 30 days (5.7 percent, p=0.85) and no statistically significant differences in 30-day mortality. RESEARCH LIMITATIONS/IMPLICATIONS: The pre-post retrospective observational study design was considered suitable to evaluate likely changes in patient flow after clinical pathway implementation, even though this design comes with limitations, describing only associations between exposure and outcome. ORIGINALITY/VALUE: Clinical pathway implementation showed an overall positive effect on patient management and service efficiency owing to the standardized application in time-dependent protocols and multidisciplinary/integrated care implementation, which improved all phases in acute ischemic stroke care.
PURPOSE: A clinical pathway for patients with acute ischemic stroke was implemented in 2014 by one Italian teaching hospital multidisciplinary team. The purpose of this paper is to determine whether this clinical pathway had a positive effect on patient management by comparing performance data. DESIGN/METHODOLOGY/APPROACH: Volume, process and outcome indicators were analyzed in a pre-post retrospective observational study. Patients' (admitted in 2013 and 2015) medical records with International Classification of Diseases, ICD-9 code 433.x (precerebral artery occlusion and stenosis), 434.x (cerebral artery occlusion) and 435.x (transient cerebral ischemia) and registered correctly according to hospital guidelines were included. FINDINGS: An increase context-sensitive in-patient numbers with more severe cerebrovascular events and an increase in patient transfers from the Stroke to Neurology Unit within three days (70 percent, p=0.25) were noted. Clinical pathway implementation led to an increase in patient flow from the Emergency Department to dedicated specialized wards such as the Stroke and Neurology Unit (23.7 percent, p<0.001). Results revealed no statistically significant decrease in readmission rates within 30 days (5.7 percent, p=0.85) and no statistically significant differences in 30-day mortality. RESEARCH LIMITATIONS/IMPLICATIONS: The pre-post retrospective observational study design was considered suitable to evaluate likely changes in patient flow after clinical pathway implementation, even though this design comes with limitations, describing only associations between exposure and outcome. ORIGINALITY/VALUE: Clinical pathway implementation showed an overall positive effect on patient management and service efficiency owing to the standardized application in time-dependent protocols and multidisciplinary/integrated care implementation, which improved all phases in acute ischemic stroke care.
Authors: Giovanni Frisullo; Valerio Brunetti; Riccardo Di Iorio; Aldobrando Broccolini; Pietro Caliandro; Mauro Monforte; Roberta Morosetti; Carla Piano; Fabio Pilato; Paolo Calabresi; Giacomo Della Marca Journal: Neurol Sci Date: 2020-07-06 Impact factor: 3.307
Authors: Giovanni Frisullo; Antonio Giulio De Belvis; Giacomo Della Marca; Carmen Angioletti; Paolo Calabresi Journal: Neurol Sci Date: 2020-06-03 Impact factor: 3.307
Authors: Loraine Busetto; Johanna Hoffmann; Christina Stang; Hemasse Amiri; Fatih Seker; Jan Purrucker; Peter Arthur Ringleb; Simon Nagel; Martin Bendszus; Wolfgang Wick; Christoph Gumbinger Journal: Int J Integr Care Date: 2022-02-21 Impact factor: 5.120
Authors: Jean-Baptiste Gartner; Kassim Said Abasse; Frédéric Bergeron; Paolo Landa; Célia Lemaire; André Côté Journal: BMC Health Serv Res Date: 2022-04-26 Impact factor: 2.908